The overall objective of the Center for the Study of Health Beliefs and Behavior is the development of models for improving communication among practitioners, patients, and families to improve the quality of patient's experience in the health care setting and to improve health outcomes. To accomplish this objective, the center and the three accompanying proposals, an "Expert System for inferring patient illness and treatment models", "Self-regulation and self-management in older asthmatics," and "Disease models, psychosocial factors and end-of-life planning", have the following specific aims: 1. To deepen our understanding of cognitive and affective processes underlying older individuals' understanding and emotional reactions to their experiences with chronic illness, and the effects of their experience on function, treatment decisions, self care, social relationships and end of life decisions. The commonsense model of self regulation (CS/SR) will be used as the framework for integrating the individual, social, institutional and cultural level processes that reflect the inter-disciplinary make up of the center faculty. 2. To translate the findings of research based on cognitive/affective science into the clinical context by developing interventions that consider all participants in the management of chronic illness: practitioners, patients, and family members. We view this as a bidirectional process, the concepts for understanding cognitive-affective processes affecting practice, and practice raising questions and suggesting concepts for inclusion in the models of patient behavior. 3. Develop, test and disseminate theory based interventions to increase the overlap of common-sense models of illness and treatments (CS/SR) held by patients and family members with each other's representations and with valid biopsychosocial models of illness and treatment. A variety of methodologies are used by each study to achieve these aims including detailed observation of provider practices, cohort designs predicting patient behaviors and health outcomes, qualitative methods, and randomized trials assessing mediating processes and testing the efficacy of specific intervention strategies. The faculty and consultants, internationally recognized experts in cognitive affective models of health behavior, health policy, basic cognitive processes, cognitive-behavioral interventions, medical sociology and geriatric medicine, are organized into four units to assist junior faculty in the development of theoretically rich and methodologically rigorous studies designed to meet our specific aims: an Administrative Core; Design and Analysis Core (e.g., qualitative methods and intervention design); Data and Instrument Sharing (development of common measures); Development of Research Agenda (defining new directions, e.g., biological processes and cost effectiveness, and assisting in grant preparation), and Faculty Development. Our ultimate vision is that the development, testing and dissemination of models to improve the bi-directional flow of information among practitioners, patients and involved family, will increase shared decision making and insure the implementation of practice guidelines by all participants. The outcome will be the ongoing re-shaping of health care policies to facilitate effective, communication practices among practitioners, patients and families. [unreadable] [unreadable]